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1. EXAMINATION OF
COGNITION AND
INTELLIGENCE
Dr.SUJA THOMAS

2. OVERVIEW.
• Cognition
• Assessment and Testing
• Related cognitive Functions
• Intelligence
• Types
• Theory
• Assessment

3. COGNITION.
• the mental action or process of acquiring knowledge and understanding
through thought, experience, and the senses.
Comprehensive textbook of psychiatry..Saddock…9nth edition.

5. COGNITION
• INTRODUCTION
• Attention language and memory serves as the building blocks for higher intellectual
functions
• Higher cognitive functions are manipulation of well learned material , abstract
thinking , problem solving , arithmetic computations
• Above functions are the highest level intellectual functions often the earliest markers
of cortical dysfunction
• These can be readily assessed by carefully history-taking about his job, job
performance, management of finances, problem solving and overall judgement.
Comprehensive textbook of Psychiatry….9nth edition.

6. COGNITION OR NEUROPSYCHIATRIC
ASSESSMENT
• Consciousness
• Orientation
• Attention
• Concentration
• Language
• Memory
• Abstract thinking
• Constuctional Ability.
• Intelligence.

7. CONSCIOUSNESS
• Term is multifaceted
• Important to distinguish between the content of consciousness and basic
arousal
• CONTENT refers to higher cognitive and emotional functioning.
• AROUSAL refers to the activation of the cortex from the ascending
activating system

8. BASIC LEVELS OF CONSCIOUSNESS
• 5 Principal levels :
• Alertness
• Lethargy or Somnolence
• Obtundation
• Stupor or semicoma and
• Coma

9. ATTENTION
• It is the patient`s ability to attend to a specific stimulus without being distracted by
extraneous internal or environmental stimuli
• Term “ vigilance” used interchangeably with sustained attention ( concentration)
• Vigilance in the sense of alertness refers to a more basic arousal process in which
the awake patient can respond to any stimulus appearing in the environment.
• Sustained attention ( CONCENTRATION ) is the ability to maintain attention to a
specific stimulus over an extended period.

10. EVALUATION OF ATTENTION
• Observation
• History
• Digit Repetition Test
• Numbers presented randomly without natural sequences ( eg., not 2-4-6-8 )
• Scoring : Average intelligence patient can accurately repeat 5 to 7 digits without
difficulty. In a non-retarded patient without obvious aphasia, inability to repeat more
than 5 digits indicates defective attention.

11. SUSTAINED ATTENTION
• Simple test administered at the bedside is the “A” Random Letter Test
• Consists of a series of random letters among which a target letter appears with
greater-than-random frequency
. Patient is required to indicate whenever the target letter is spoken by the examiner.
Examples of common organic errors
- Omission error
- Commission error
- Perseveration error

12. SUSTAINED ATTENTION
• Serial Sevens Subtraction Test ( eg., counting backward from 100 by 7s :
100,93, 86,…….)
• Results of studies of performance by normal people suggest that errors on
this test may be influenced by intellectual capacity, education, calculating
ability or socioeconomic status.

13. UNILATERAL INATTENTION
• Unilateral inattention ( Suppression or Extinction ) tested during the routine sensory
examination by using DOUBLE ( Bilateral ) SIMULTANEOUS STIMULATION.
• DSS is tested in all major sensory modalities:
• Tactile testing
• Visual testing
• Auditory testing
-Before undertaking this test , the examiner must ensure that the basic sensation for each
modality is intact bilaterally.

14. UNILATERAL INATTENTION
• EXTINCTION is present when the patient supresses the stimuli from one
side of the body.
• May occur in all modalities ( polymodal neglect ) or may be restricted to a
single modality.
• When extinction is elicited, the degree of inattention can be assessed by
increasing the magnitude of the stimulus on the inattentive side.

15. ANATOMY AND CLINICAL
IMPLICATIONS
• Basic anatomic structures responsible for maintaining an alert state are the brain
stem reticulating activating system and the diffuse thalamic projection system.
• The most common cause of decreased attention and vigilance in a hospital
population is diffuse brain dysfunction ( delirium ).
• Patients with bilateral lesions of the frontal lobes or the limbic system ( eg.,
Korsakoff`s syndrome ) have a type of inattention that is characterised by
indifference and perseveration.
• Clinically these patients usually perform well on the digit repetition task but cannot complete
the “A” Random letter test accurately. They fail to recognise an “A” at the end of a long
sequence (eg., U C J T O E A ) because their attention has wandered.

16. LANGUAGE
• Basic tool of human communication and the basic building block of most
cognitive abilities.
• Demonstration of a specific language disturbance is pathognomonic of
brain dysfunction.
• Language system should be evaluated in an orderly fashion.

17. EVALUATION OF LANGUAGE
• Handedness
• Spontaneous speech
• Eliciting speech production
• Observing spontaneous speech
• Verbal fluency
• Comprehension
• Repetition
• Naming and word finding
• Reading
• Writing
• Spelling

18. EVALUATION OF LANGUAGE SYSTEM.
• Handedness :
• Ask whether he or she is right – or left handed
• Ask the patient to demonstrate which hand is used to hold a knife, stir coffee and flip a
coin.
• Also ask the patient about any tendency to use the opposite hand for any skilled
movement.
• Family history of left-handedness or ambidexterity is important because handedness
and cerebral dominance for language are significantly influenced by heredity.

19. EVALUATION OF LANGUAGE
• Spontaneous speech
• Eliciting Speech production
• First step is to listen carefully to the spontaneous speech
• It is wise to ask the patient to discuss reatively uncomplicated issues such as “ Tell me why
you are in the hospital” or “ Tell me about your work”.
• Pictures may be used to stimulate speech.

20. EVALUATION OF LANGUAGE
• Observing Spontaneous speech :
• Clinical obsevations are made and noted while listening
• Is speech output present ?
• Is the speech dysarthric or dysprosodic (interruption of speech melody ) ?
• Is there evidence of specific aphasic errors ( eg., errors of syntax, word-finding pauses,
abnormal words or paraphasias ) ?

21. EVALUATION OF LANGUAGE
• VERBAL FLUENCY
• Ability to produce spontaneous speech fluently without undue word- finding pauses or
failure in word searching
• Overall impression gained by listening to the patient`s spontaneous speech
• Two easily administered evaluations are the Animal-Naming Test and the FAS Test ( a
controlled oral word association test ).
• For animal naming, instruct patient to recall and name as many animals as possible. Time the
patient`s performance for 60 seconds
• Normal individual should produce from 18 to 22 animal names during a 60-second period.

22. EVALUATION OF LANGUAGE
• VERBAL FLUENCY
• The FAS Test consists of 3 separate , timed word-naming trials, using the letters “F” ,
“A”, and “S” respectively
• Patient is instructed to name as many words as possible ( not including proper names )
that begin with the stipulated letter during each 60 second trial.
• Normal people name 36 to 60 words , with performance depending in part on age,
intelligence , and educational level.
• An inability to name 12 or more words per letter is indicative of reduced verbal fluency

23. EVALUATION OF LANGUAGE
• COMPREHENSION :
• Must be tested in a structured fashion , without reliance on the patient`s
ability to answer verbally
• Common error in assessing comprehension is to ask the patient to answer
general or open-ended questions.
• 2 methods of testing comprehension : Pointing commands and Questions
that can be answered with a “yes” or “no” response

24. EVALUATION OF LANGUAGE
• COMPREHENSION :
• Testing the patient`s ability to point to single objects in the room, body parts, or articles
collected from the examiner`s pockets (eg., coins, comb, pencil, keys ) is an excellent way to
quantify single-word comprehension.
• Task may be increased in complexity ( eg., “ Point to the wall, the window and your nose”).
Increase the number of objects until the patient consistently fails.
• Patient of average intelligence without aphasia should succeed in pointing to 4 objects or
more.
• This test provides an evaluation of single-word comprehension, auditory retention, and
sequence memory.

25. EVALUATION OF LANGUAGE
• COMPREHENSION :
• Next , a series of simple and complex questions that require only “yes” or “no” answers
should be asked.
• For example, “Is this a hotel ?” or “Is it raining today?”
• It is important to ask at least 7 questions because correct responses can occur by chance
alone 50% of the time with “yes” and “no” questions.
• Correct answers should alternate between “yes” to “no” randomly because of the
tendency for brain-damaged patients to perseverate.

26. EVALUATION OF LANGUAGE
• COMPREHENSION :
• Many clinicians test language comprehension by asking patients to carry out motor
commands such as “Show me how to light a cigarette” or “Stick out your tongue.”
• If the patient correctly carries out such commands, he or she has certainly understood them.

27. EVALUATION OF LANGUAGE
• REPETITION :
• Complex process that can be affected by impaired auditory processing, disturbed
speech production, or disconnection between receptive and expressive language
functions.
• Testing should present material in ascending order of difficulty, beginning with single
monosyllabic words and proceeding to complex sentences. Patient should be asked to
repeat the word or sentence verbatim after the examiner.
• Normal people and brain-damaged patients without aphasia can accurately repeat
sentences of 19 syllables.

28. EVALUATION OF LANGUAGE
• NAMING AND WORD FINDING:
• Asking the patient to describe a picture that contains objects and actions usually brings
out any word-finding defect.
• Confrontation naming test – Examiner selects from 10 to 20 items.
• Several categories of objects should be used ( colors, body parts, room objects, articles
of clothing, and parts of objects).
• It is important to use uncommon ( low frequency usage ) items as well as common (
high frequency of usage ) items.

29. NAMING AND WORD FINDING.

30. EVALUATION OF LANGUAGE
• READING :
• Directly related to educational experience.
• Both reading comprehension and reading aloud ability should be tested.
• If the patient is not aphasic, screen for alexia by having the patient read a paragraph from a newspaper
or magazine.
• To test reading in patients with aphasia, begin with having them read aloud first short single words,
then phrases, sentences, and finally paragraphs.
• If they succeed at the lower levels, then have the patients read the names of objects in the room or on
display and point to them.
• Finally, have patients read questions that can be answered “yes” or “no” or ask them questions about
what was written.

31. EVALUATION OF LANGUAGE
• READING:
• For eg., if the patient read the sentence “ The boy and girl walked in the snow,” the
examiner could ask, “Did the boy go alone?” or “Was it raining when the boy and girl
went for a walk ?”
• Examiner should note any syllable or word substitutions ( paralexic errors ), omitted
words, and defects in comprehension.

32. EVALUATION OF LANGUAGE
• WRITING :
• AGRAPHIA is diagnosed when a patient demonstrates basic language errors, gross spelling errors, or
or use of paragraphias ( word or syllable substitutions).
• To test writing, first have the patient write letters and numbers to dictation.
• Second, ask the patient to write the names of common objects or body parts.
• Third, if the patient can successfully write single words, ask them to write a short sentence describing
the weather, their job, or a picture from a magazine.
• Asking patients to write their name is not always particularly meaningful because name writing may be
preserved even in the presence of gross agraphia.
• In the literate patient without aphasia, the examination can begin with this sentence-writing task.
•

33. EVALUATION OF LANGUAGE
• SPELLING:
• A complex , little-studied , higher-language function that is strongly associated with
educational experience.
• For practical purposes, spelling can be evaluated by asking the patient to spell dictated
words.
• Gross errors in spelling can be detected in bedside testing.

34. MEMORY
• A disturbance in memory is the most common cognitive complaint of patients with organically based
behavioural syndromes.
• MEMORY is a general term for a mental process that allows the individual to store information for later
recall.
• The memory process consists of 3 stages :
• In the first stage, the information is received and registered by a particular sensory modality ( eg., touch, auditory, or
visual). Once the sensory input has been received and registered, that information is held temporarily in short-term memory
(working memory).
• The second stage consists of storing or retaining the information in a more permanent form ( long-term memory).
• The final stage in the memory process is the recall or retrieval , of the stored information. This retrieval is an active process
of mobilizing stored information on request or as needed ( so-called declarative memory).

35. MEMORY
• Clinically , memory is subdivide into 3 types, based on the time span between
stimulus presentation and memory retrieval.
• “Immediate”, “ recent”, and “remote”—basic memory types.
• Immediate memory, or immediate recall, is used to recall a memory trace
after an interval of a few seconds, as in the repetition of a series of digits.
• Sometimes short-term memory is also used to describe this memory type.

36. MEMORY
• RECENT MEMORY is the patient`s capacity to remember current , day-to-
day events (eg., the current date, the doctor`s name, what was eaten for
breakfast, or recent new events).
• More strictly defined, recent memory is the ability to learn new material and
to retrieve that material after an interval of minutes, hours, or days.

37. MEMORY
• REMOTE MEMORY traditionally refers to recall of facts or events that
occurred years previously, such as the names of teachers and old school
friends, birth dates, and historic facts.
• In patients with a specific defect in new learning (recent memory), remote
memory refers to the recall of events that occurred before the onset of the
recent memory defect.

38. MEMORY EVALUATION
• In the mental status examination , each aspect of memory should be
assessed in some detail.
• The accurate assessment of memory require that any question asked by the
examiner be verifiable from a source other than the patient.
• Personal information concerning the patient`s social history, lifestyle,
vocation, and so forth should be verified by the patient`s family or friends.

39. MEMORY EVALUATION
• IMMEDIATE RECALL ( SHORT-TERM MEMORY) :
• Tested by digit repetition
• Backward digit repetition used by some examiners to assess verbal memory
• Highly complex task
• It is useful as a general screening test for brain dysfunction.

40. MEMORY EVALUATION
• ORIENTATION ( RECENT MEMORY) :

41. MEMORY EVALUATION
• REMOTE MEMORY :
• Remote memory tests such as those included here evaluate the patient`s ability to recall
personal and historic events.

42. MEMORY EVALUATION
• TEST ITEMS :
• HISTORIC FACTS : Ask the patient to name 4 people who have been president during
the patient`s lifetime. The normal patient should be able to accomplish this task
without difficulty.
• Ask the patient when India got independence….If the patient has no memory for these
major events, this implies deficient memory.

43. NEW- LEARNING ABILITY
• This assesses the patient`s ability to actively learn new material ( to acquire new
memories).
• Adequate performance require the integrity of the total memory system.
• FOUR UNRELATED WORDS : Have him or her repeat the words after their
presentation. Correct any errors made on immediate repetition.
• When a patient is given 4 or 5 trials to repeat the words accurately, this usually
forecasts a significant memory problem.
• TEST ITEMS : 1. Brown 2. Carrot 3. Happiness 4. Rose.

44. NEW LEARNING ABILITY
• When a patient cannot recall a given word, it is often possible to obtain an
indication of memory storage by the use of verbal cues.
• Semantic cues ( eg. “One word was a color”)
• Phonemic cues using syllabic components of the word ( eg., “Happ…..[happiness]”)
• Contextual cues ( eg., “a flower”)
-The demonstration of good memory on recognition testing but poor memory on free
recall is called IMPLICIT MEMORY.

45. NEW LEARNING ABILITY
• SCORING:
• The normal patient under age 60 should accurately recall 3 or 4 of the words after a 10-
minute delay.
• Normal persons over age 80 retain an average of only 2 of 4 words over 5 minutes.

46. VERBAL STORY FOR IMMEDIATE
RECALL.
• DIRECTIONS:
• Tell the patient, “I am going to read you a short paragraph. Listen carefully, because
when I finish reading, I want you to tell me everything that I told you.”
• For older patients , read the story more slowly to give them adequate time to process
the information.
• After reading the story, say “Now tell me everything that you can remember of the
story. Start at the beginning of the story and tell me all that happened.”
• As the patient retells the story, indicate the number of items recalled. ( 26 items –10 ,
under age 70).

47. VISUAL MEMORY ( HIDDEN OBJECTS)
• Especially useful in evaluating the memory of patients with aphasia.
• DIRECTIONS :
• Examiner may use any 5 small, easily recognizable objects that may be readily hidden in the patient`s vicinity.
• Commonly used items are pen, comb, keys, coin , and fork.
• The objects are hidden while the patient is watching.
• Name each item as it is hidden to ensure that the patient is aware of which object was hidden in what place.
• Then provide interfering stimuli for 5 minutes by asking the patient routine questions, or engaging the patient
in general conversation.
• After this period, ask the patient to name and indicate the location of each of the hidden objects.
• Average patient under age 60 should find 4 or 5 of the hidden objects of the hidden objects after a 5-minute
delay without difficulty.

48. PAIRED ASSOCIATE LEARNING (PAL)
• PAL is commonly used in standard memory batteries and is another highly sensitive measure of new-
learning ability.
• DIRECTIONS:
• Tell the patient, ”I am going to read you a list of words, two at a time. Listen carefully because I will expect you to remember
the words that go together. For eg., if the words were ‘big’ and ‘little’, I would expect you to say the word ‘little’ after I said
the word ‘big’.
-PRESENTATION LISTS:
• Weather---Box
• High---Low
• House---Income
• Book---Page
-SCORING: A normal patient under age 70 is expected to recall the two “easy” paired associates ( high—low, book—page ) and at
least one of the “hard” associates of the first recall trial, and to recall all paired associates on the second trial.
• The total PAL score is the best measure of verbal learning.

49. CONSTRUCTIONAL ABILITY
• CA { Constructional praxis or Visuoconstructive ability} is the ability to
draw or construct two-or three-dimensional figures or shapes.
• A high-level, nonverbal cognitive function, constructional ability is a very
complex perceptual motor ability involving the integration of occipital,
parietal, and frontal lobe functions.
• Copying line drawings using pencil on paper, reproducing matchstick
patterns, and reconstructing block designs are all examples of routinely used
tests of constructional ability.

50. SELECTING TESTS OF
CONSTRUCTIONAL ABILITY
• Warrington has listed 6 basic types of tests for eliciting evidence of constructional
impairment:
• Two-dimensional block designs
• Paper- and pencil reproduction of geometric shapes
• Spontaneous drawings
• Stick-pattern reproduction
• Three-dimensional block constructions
• Spatial analysis tasks that require the patient to shade in the portion of a design that is
common to two or more overlapping figures.

51. TESTS OF CONSTUCTIONAL ABILITY
• Reproduction drawings and drawings to command are the easiest tests to
administer and interpret.

52. CONSTRUCTIONAL ABILITY TESTS
• DRAWINGS TO COMMAND :
• The patient is required to draw 3 pictures, according to verbal commands.
• Introduce the test by saying, “ I would now like you to draw some simple picture on
this paper. Please draw a picture of a clock with the numbers and hands on it ; a flower
in a pot; and a house, so that you can see two sides and the roof.”
• Scores of 0(poor), 1(fair), 2(good), 3(excellent) are given.

53. HIGHER COGNITIVE FUNCTIONS
• Includes manipulation of well –learned material, abstract thinking, problem solving,
judgement ,arithmetic computations, and so forth.
• May be categorized in the following hierarchic groupings:
1) The fund of acquired information or the store of knowledge
2) The manipulation of old knowledge ( eg., calculations or problem solving )
3) Social awareness and judgement
4) Abstract thinking ( eg., interpretation of proverbs or the completion of a
conceptual series )

54. FUND OF INFORMATION
• Presented in order of increasing difficulty
• Continue to ask questions until the test is completed or until the patient has
failed 3 successive questions.
• Average patient should answer minimum of 6 questions.

55. CALCULATIONS
• Complex neuropsychologic functions that involve the somewhat distinct
components of number sense and manipulation.
• Components of calculation include :
• Rote tables ( eg., addition, subtraction, and multiplication)
• The basic arithmetic concept of carrying and borrowing
• Recognition of the signs ( +, - , X, ÷)
• Correct spatial alignment for written calculations.

56. PROVERB INTERPRETATION
• Interpreting proverbs accurately requires an intact fund of general information, the ability to
apply this knowledge to unfamiliar situations, and the ability to think in the abstract.
• DIRECTIONS:
• Proverbs are presented in ascending order of difficulty.
• To aid in scoring, examples of abstract (2 points); semiabstract (1 point); and concrete (0 points) responses to
each proverb follow.
• Eg., DON`T CRY OVER SPILLED MILK.
• 0-Concrete “The milk`s all over the floor.” OR “When the milk is on the floor, you can`t use it.”
• 1-Semiabstract “It`s gone; don`t worry about it.” OR “Don`t cry when something goes wrong.”
• 2-Abstract “Once something is over, don`t worry about it.” OR “Don`t be concerned about about events that
are beyond control.”
- Concrete responses are pathologic in all.
- -A total score of less than 5 on proverb interpretation is suspicious.

57. SIMILARITIES
• In the Verbal Similarities Test, the patient must explain the basic similarity between two overtly different objects or situations.
• This test of verbal abstract ability requires analysis of relationships, formation of verbal concepts, and logical thinking.
• TEST ITEMS:
• Turnip-cauliflower
• Car-airplane
Car-Airplane
2 points : Modes of transportation
1 point: Drive them both ; both have motors
0 points: One`s in the air and one`s on the road.
- The nonretarded patient with a normal educational background should obtain a score of 5 or 6 on this test.
- Two concrete (0-point) responses or a total score of less than 4 suggests reduced general intelligence or
impaired thinking ability.

58. RELATED COGNITIVE FUNCTIONS
• Apraxia
• Right – Left Orientation
• Stereognosis
• Geographic Orientation

59. RELATED COGNITIVE FUNCTIONS
• APRAXIA :
• An acquired disorder of learned skilled sequential motor movements that cannot be
accounted for by elementary disturbances of strength, coordination, sensation, or lack
of comprehension or attention.
• It is an impairment in selecting and organizing the motor innervations needed to
execute an action.

60. IDEOMOTOR APRAXIA
• Most common type of apraxia.
• Buccofacial apraxia.
• Limb apraxia
• Apraxia of whole body movements

64. IDEATIONAL APRAXIA
• It refers to a breakdown in performance of a task that involves a series of
related, but separate steps, such as folding a letter, placing it in a envelope,
sealing it, and then putting a stamp on it.

65. SIMPLE TASKS TO DEMONSTRATE
IDEATIONAL APRAXIA.

66. RIGHT-LEFT ORIENTATION
• Right-left orientation is traditionally defined as the ability to distinguish right from left on oneself and in the
environment (eg., on the examiner`s body).
• This ability is basically a capacity for spatial orientation.
• EVALUATION:
• TEST ITEMS:
• Identification on self
• Crossed commands on self
• Identification on examiner
• Crossed commands on examiner.
- If an acquired disorder of right-left orientation is present, the lesion is usually located in the parietotemporal-occipital region of
the dominant hemisphere.

67. FINGER AGNOSIA
• Inability to recognise, name, and point to individual fingers on oneself and on
others.
• Disorder may be most readily demonstrated in reference to the index, middle, and
ring fingers.
• TEST ITEMS :
• Nonverbal finger recognition
• Identification of named fingers on examiner`s hand.(eg. “Point to my middle finger.”).
• Verbal identification (naming) of fingers on self and examiner. (eg., Index finger—”What is
the name of this finger?”).

68. STEREOGNOSIS
• It is the ability to discriminate the size and shape of objects and to identify them by
touch alone
• Routinely tested during neurologic examination.
• Ask the patient to identify several common objects placed in his or her hand (eg.,
coin, key, paper clip, and so forth).
• Patient is tested with eyes closed and is given one object at a time.
• Classic astereognosis , or a failure of tactile recognition ( tactile agnosia) indicates a
lesion in the anterior portion of the parietal lobe.

69. GEOGRAPHIC ORIENTATION
• It is a complex ability that includes the patient`s capacity to find his or her way in familiar
environments, to localize places on maps or floor plans, and to find his or her way in new
environments.
• EVALUATION:
• History obtained from family (eg., does patient become lost at work, in the neighbourhood, or at
home?)
• Localizing places on map (eg., India, Sri lanka, Pakistan. )
• Ability to orient self in hospital environment.(eg., capacity to find their bed, ward ,etc)
- Geographical disorientation has been clinically associated with parietal lobe disease.
- -General lack of geographical knowledge is the most common cause of failure on the map test.

70. STANDARD NEUROPSYCHOLOGICAL
ASSESSMENT METHODS
• TESTS OF GENERAL COGNITIVE FUNCTIONING:
• Wechsler Adult Intelligence Scale—Third Edition(WAIS-III)---Clinical assessment of intelligence in
patients between age 16 and age 89.It provides data that quantify general intellectual functioning (Full-Scale
IQ), verbal and nonverbal performance(Verbal and Performace Scale IQs), and specific performance in ht
areas of verbal-comprehension, perceptual-organization,working memory(attention), and processing speed.
• TESTS OF ATTENTION AND VIGILANCE:
• Digit Repetition
• “A” Random Letter for Vigilance
• Letter and Symbol Cancellation Tasks—Tasks typically include an array of randomly presented visual
stimuli, with a given target item that must be noted and crossed out (eg., letter, number, and symbol).
• Paced Auditory Serial Addition Test ( PASAT).-Highly demanding and sensitive test of active sustained
verbal attention, information processing, and basic ability to calculate. Patient is instructed to add each digit
pair (eg., “2-9(11); 5-3(8); 4-6(10)…….)

71. STANDARD NEUROPSYCHOLOGICAL
ASSESSMENT METHODS
• TESTS OF LANGUAGE FUNCTIONING :
• Peabody Picture Vocabulary Test—Easily administered test of single –word vocabulary comprehension. Norms are provided for age groups
between 21/2 and 90 years. Test is composed of two equivalent 204-item word lists presented verbally in ascending order of difficulty.
• Token Test---Uses colored plastic tokens that are manipulated by the patient in response to a series of hierarchically ordered verbal commands
(eg., ranging from “Show me a circle” to “ After touching the yellow square, pick up the blue triangle”).It is useful in the assessment of aphasic
patients.
• Boston Naming Test---BNT is an objective measure of visual confrontation. It require the patient to name a difficulty-graded series of pictured
objects, ordered in increasing difficulty from “bed” to “abacus”.
• Verbal Fluency Tests--- Controlled Oral Word- Association Test(FAS)
• Animal Naming Test (60 seconds).
• Comprehensive Aphasia Batteries—
• BDAE ( Boston Dignostic Aphasia Examination)
• Communication Abilities in Daaily Living
• MAE-3 (Multilingual Aphasia Examination---Third Edition
• Neurosensory Center Comprehensive Examination for Aphasia
• Western Aphasia Battery.

72. STANDARD NEUROPSYCHOLOGICAL
ASSESSMENT METHODS.
• TESTS OF MEMORY :
• Wechsler Memory Scale—Third Edition (WMS-III)---Includes a measure of general memory (actually
composed of auditory and visual delayed recall), as well as indices of immediate memory (auditory and visual)
, working memory (auditory and visual), and auditory recognition (delayed).
• Memory Assessment Scales ( MAS)---Comprehensive battery for assessing memory functioning in adults.
The MAS includes 12 subtests, based on 7 learning and recall tasks, and provides summary scores for short
term memory (verbal span and visual span ), verbal memory ( word list recall and immediate recall of a logical
paragraph), visual reproduction (15-second recall of visual designs and immediate visual recognition of visual
designs) and global memory.
• Rey Auditory Verbal Learning Test (RAVLT) ; California Auditory Verbal Learning Test (CAVLT)---
Easily administered tests of immediate verbal memory span, verbal learning, and immediate and delayed
recall.
• Benton Visual Retention Test ; Memory for Designs Test :-- BVRT and MFD test are measures designed
to assess visual perception and analysis, short-term visual memory, and paper- and pencil constructional
ability. Each includes a series of graduated simple-to-complex line drawings that the patient must visually
analyse and then copy. Both incorporate a memory component.

73. STANDARD NEUROPSYCHOLOGICAL
ASSESSMENT METHODS.
• TESTS OF ABSTRACTION AND HIGHER COGNITIVE FUNCTION:
• Category Test---Most sensitive to the effects of brain dysfunction. The test consists of 7
subtests of varying complexity, each with a different underlying principle(eg., size, shape,
color, and position)…Related to age, education, and intelligence.
• Wisconsin Card-Sorting Test(WCST)---Designed to assess abstract ability, conceptual set
shifting, and “learning to learn”,
• Raven`s Progressive Matrices---Are a series of tests of visuospatial analysis, spatial
conceptualization, and numeric reasoning. Each of the test forms requires the patient to
select, from a series of alternative possibilities, the pictured pattern or segment of a pattern
that best matches or completes the stimulus figure. The matrices are useful for assessing
visual pattern analysis, matching, nonverbal reasoning, unilateral neglect, and cognitive style.

74. WISCONSIN CARD-SORTING TEST
• Designed to assess abstract ability, conceptual set shifting
• Require the patient to sort a series of stimulus cards that vary in color, form and
number by matching to a simple array containing a RED triangle, Two GREEN
stars, Three YELLOW crosses, and Four BLUE circles
• Examiner tells the patient whether his match is correct or incorrect after each trial
• Designated “ correct “ matches are, in sequence: color-form-number-color- form-
number.
• Provides an objective measure of abstraction and problem solving

75. RAVEN`S PROGRESSIVE MATRICES
• Series of tests of visuospatial analysis, spatial conceptualization, and
numeric reasoning
• Test available in 3 difficulty levels
• Patient has to select , from a series of alternative possibilities, the pictured
pattern or segment of a pattern that best matches or completes the stimulus
figure.

76. STANDARD NEUROPHYCHOLOGICAL
ASSESSMENT METHODS
• TESTS OF CONSTRUCTIONAL ABILITY;
• Bender Gestalt Test---Patient is presented with a series of simple and more difficult geometric line drawings,
which are copied.. The patient`s design reproductions can be objectively scored for the errors of integration,
distortion, perseveration, and rotation.
• Raven`s Progressive Matrices—These tests are useful in assessing the visuospatial analytic component of
the constructional process.
• Benton Visual Retention Test---This well-standardized test can also be used to evaluate both reproduction
constructional ability (design copying) and short-term recall reproduction( constructions from memory).
• Hooper Visual Organization Test(HVOT)---A measure of visual analysis and organization and of the
ability to synthesize disparate arts into a meaningful gestalt without a motor component.The test includes a
series of line drawings of increasing complexity that have been cut into a variety of separate parts. The patient
must identify the pictured object by mentally organizing the various parts. The HVOT is essentially a
“constructional” test without a motor-output component.

78. • Have you ever consciously considered these questions ?
• Am I an intelligent person?
• How intelligent am I ?
• How do we judge if someone is intelligent or not ?
• How can we measure the intelligence of a person ?

79. • There are some questions too :
• What is intelligence ?
• Is intelligence how one deals with
others ? Or
• Is intelligence how precisely we learn a
new task ? Or
• Is it how good we are in our studies ?
Or
• Is intelligence how well we can solve
problems ? Or
• Is it how we accurately judge people ?
Or
• Is intelligence all of this , or even more
than all this ?
• Different people may understand
intelligence differently.
• If you think intelligence is all of this or
even more than all this, then you are
right.

80. INTELLIGENCE
• “ The capacity to acquire and apply knowledge”
• ( intelligence, 1993, the American Heritage College dictionary )
Comprehensive textbook of Psychiatry….9nth edition.

81. WHAT IS INTELLIGENCE ?
• Intelligence is the ability to learn about, learn from, understand and interact with
one`s environment. This general ability consists of a number of specific abilities:
• Adaptability to a new environment or to change in the current environment
• Capacity for knowledge and the ability to acquire it
• Capacity for reason and abstract thought
• Ability to comprehend relationships
• Ability to evaluate and judge
• Capacity for original and productive thought
Comprehensive textbook of Psychiatry….9nth edition.

82. INTELLIGENCE
• According to Feldman “ intelligence is the capacity to understand the world ,
think rationally, and use resources effectively when faced with challenges “
• Types of Intellingence:
• PRACTICAL
• EMOTIONAL

83. PRACTICAL INTELLIGENCE
• According to Sternberg, intelligence related to overall success in living.
• Career success requires PI apposed to academic success.
• Developed through observations of others` behaviors.

84. EMOTIONAL INTELLIGENCE (EQ)
• The set of skills that trigger the accurate assessment , evaluation, expression,
and regulation of emotions.
• The ability to monitor one`s own and other`s emotions.
• To discriminate among emotions etc

85. GARDENER`S MULTIPLE FACTOR
THEORY.

86. ASSESSING INTELLIGENCE
• - Intelligence TESTS : Tests devised to quantify a person`s level of
intelligence.
• - The first formal measure of intelligence was developed by French
psychologist Alfred Binet and Theodore Simon, in 1905 in France.
• - His test items include : names of parts of body, compare lengths and
weights, counting coins, naming objects in a picture, filling in the missing
words in a sentence etc.
Introduction To Psychology--- 7nth edition;Morgan and King

87. ASSESSING INTELLIGENCE
• 3 YEARS
• - Shows nose, eyes and mouth. Repeats two digits. Describes objects in a picture.
Gives family name. Repeats a sentence of six syllables.
• 15 YEARS
• - Repeats seven digits. Gives three rhymes. Repeats a sentence of 26 syllables.
Interprets a picture . Solves a problem from several facts.
Introduction to Psychology…Morgan and king

88. Assessing intelligence
• - Wechsler Adult Intelligence Scale – Revised
• Psychologist David Wechsler developed both.
• The two tests consist of 2 major parts :
1. Verbal part/ scale
2. Performance or non verbal part / scale
Introduction to Psychology…Morgan and king

89. ASSESSING INTELLIGENCE
• - VERBAL SCALE:
• Consists of more conventional types of problems involving vocabulary definition, and
comprehension of various concepts.
• The subscales include :
• Information
• Comprehension
• Arithmetic
• Similarities

90. ASSESSING INTELLIGENCE
• -Performance Scale
• It involves assembling small objects and arranging pictures in a logical order.
• The subscales include :
• Digit symbol
• Picture completion
• Object assembly

95. REFERENCES
• The Mental Status Examination in Neurology—4rth edition. Richard
L.Strub, F.William Black.
• Comprehensive Textbook of Psychiatry---9nth edition. Saddock.
• Introduction to Psychology—Morgan and King.